NPI | 1497747513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071-002872) |
Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071-002872) |
103TP2701X Psychologist, Group Psychotherapy (Licence: IL 071-002872) | |
Enumeration Date | 2005-08-16 |
Last Update Date | 2015-01-19 |